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Introduction. Seasonal influenza epidemics represent a cost that affects companies in terms of sick leave and lost productivity, theref ore vaccination can improve occupational health. The vaccination of Healthcare Workers (HCW) has a dual function because in addition to protecting the workers, it also protects the most fragile patients. The students of medical and nursing degree courses, as well as other health professions, attend the workplace daily and are similar to workers in Legislative Decree 81/08. The purpose of this research is to assess the prevalence of students who are in favor of the introduction of a mandatory vaccination for healthcare workers, and to investigate what factors predispose them to be favorable. Methods. We performed a multi-center cross-sectional study using a validated questionnaire in a sample of students from different university courses from October 10th, 2017 to September 30th, 2018. For qualitative variables, absolute and relative frequencies, and for categorical variables Pearson's Chi-square test (X2) were calculated. A multivariable logistic regression model was used. Results. A total of 3131 questionnaires were completed by 2132 women and 999 men. The prevalence of students who are favorable to the introduction of a mandatory flu vaccination is 87.3% and that this data is linked to the female gender (aOR 1.52 CI 95% 1.12-2.06), being a medical student compared to nursing (aOR 2.14 CI 95% 1.45-3.17), coming from central Italy (aOR 3.08 CI 95% 2.11-4.51) and northern Italy (aOR 3.09 CI 95% 2.12-4.49) compared to Southern Italy and the Islands, wanting to get vaccinated for the next season (aOR 6.37 CI 95% 3.73-10.88), declaring to have a good/excellent level of knowledge on vaccine-preventable diseases (aOR 1.44 CI 95% 1.04-1.99), planning a recommendation based on ministerial indications (aOR 2.12 CI 95% 1.28-2.30) and having received requests for clarification on vaccinations (aOR 2.02 CI 95% 1.44-2.85). Discussion. The sample of university students showed to be largely in agreement with the introduction of mandatory vaccination for HCW, which is important for the prevention of influenza virus in the workplace. To increase adherence of healthcare workers to vaccination campaigns against seasonal influenza in the workplace, it is necessary that operative strategies are implemented with educational messages.

Malformations of the central nervous system (CNS) encompass a heterogeneous group of congenital anomalies that may be isolated or appear as part of a genetic syndrome. Advances in identifying the genetic etiology underlying many CNS malformation and syndromes have led to the current genetic-based classifications that allows us to better estimate prognosis and potential complications. Herein, we discuss the main genetic, clinical and radiological features and their implications for diagnostic testing and disease management

Objective: To test the hypothesis that some metalloproteinases (MMP-2, MMP-9) and inducible nitric oxide synthetase (iNOS) enzymes in dental pulp samples do not vary when subjected to orthodontic treatment. Materials and Methods: Human dental pulps were taken from male and female patients (N=10; age 10–14 years). A straight wire technique was used with nickel-titanium or steel archwires. The increase of pressure applied on teeth was gradual. Five patients were subjected to premolar extractions after 14 months of treatment and one after 24 months. Samples were Bouin-fixed, paraffin-embedded, and afterwards processed for immunohistochemistry using anti-MMP-2, anti-MMP-9, and anti-iNOS antibodies. Results: A reduction of MMP-2, MMP-9, and iNOS expression occurred in treated samples. This became more evident with increased treatment time. Conclusion: The hypothesis is rejected. The reduction of expression of those proteins revealed a time-dependent relationship.

BACKGROUND: Zika virus (ZIKV) is an arthropod-borne virus transmitted through infected mosquitos. The aim of this Italian nation-wide study was to evaluate general population's knowledge and attitudes towards ZIKV, its transmission, and travel-related preventive measures. METHODS: This cross-sectional study was conducted between July and August 2017, through a validated questionnaire. Predictors of knowledge were analysed through multivariate regression. RESULTS: Among 1119 respondents, 20% and 71% knew etiological agent and transmission route of ZIKV infection, respectively. Approximately 43% ignored the preventive measures to be taken after returning from endemic areas. At multivariate analysis, predictors of poor knowledge were age, living in Central or South Italy and Islands, being poorly educated, having never heard of or attended a travel clinic. CONCLUSIONS: This study captures an overall poor knowledge of Zika among general public. This research highlights the need of designing and implementing measures to improve travellers' awareness and protection against ZIKV.

Aim: Due to the introduction of the compulsory vaccination law in Italy, and the following intense debate, the aim of this study was to assess the opinion of Italian Public Health residents and their knowledge on this issue. Subjects and methods: Data were collected using a previously developed and validated online questionnaire that was sent by email to Public Health Residents attending the 35 Post-Graduate Schools of Hygiene and Preventive Medicine in Italy. Multivariate stepwise logistic regression was performed for data analysis, and a 0.05 level of significance was chosen. Results are expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CI). Results: Out of 554 medical doctors, 359 filled in the questionnaire, of which 56.8% were female. Those who had a positive opinion about the Law also strongly agreed/agreed with the following statements: caregivers who do not comply with the mandatory vaccination law should be fined; the Law is the only way to prevent, contain and reduce public health risks; documentation of legally mandated vaccines should be required for children to attend preschools; mandatory vaccinations are necessary and the Decree Law should not be modified; the Law emphasises the importance of all the vaccinations provided by the National Immunisation Plan. Conclusion: Italian Public Health residents agree with compulsory vaccination, considering it a useful and effective tool aimed at increasing the vaccination coverage rate.

Background: The medium-term and long-term impact of COVID-19 in patients with cancer is not yet known. In this study, we aimed to describe the prevalence of COVID-19 sequelae and their impact on the survival of patients with cancer. We also aimed to describe patterns of resumption and modifications of systemic anti-cancer therapy following recovery from SARS-CoV-2 infection. Methods: OnCovid is an active European registry study enrolling consecutive patients aged 18 years or older with a history of solid or haematological malignancy and who had a diagnosis of RT-PCR confirmed SARS-CoV-2 infection. For this retrospective study, patients were enrolled from 35 institutions across Belgium, France, Germany, Italy, Spain, and the UK. Patients who were diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, and entered into the registry at the point of data lock (March 1, 2021), were eligible for analysis. The present analysis was focused on COVID-19 survivors who underwent clinical reassessment at each participating institution. We documented prevalence of COVID-19 sequelae and described factors associated with their development and their association with post-COVID-19 survival, which was defined as the interval from post-COVID-19 reassessment to the patients’ death or last follow-up. We also evaluated resumption of systemic anti-cancer therapy in patients treated within 4 weeks of COVID-19 diagnosis. The OnCovid study is registered in ClinicalTrials.gov, NCT04393974. Findings: 2795 patients diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, were entered into the study by the time of the data lock on March 1, 2021. After the exclusion of ineligible patients, the final study population consisted of 2634 patients. 1557 COVID-19 survivors underwent a formal clinical reassessment after a median of 22·1 months (IQR 8·4–57·8) from cancer diagnosis and 44 days (28–329) from COVID-19 diagnosis. 234 (15·0%) patients reported COVID-19 sequelae, including respiratory symptoms (116 [49·6%]) and residual fatigue (96 [41·0%]). Sequelae were more common in men (vs women; p=0·041), patients aged 65 years or older (vs other age groups; p=0·048), patients with two or more comorbidities (vs one or none; p=0·0006), and patients with a history of smoking (vs no smoking history; p=0·0004). Sequelae were associated with hospitalisation for COVID-19 (p

Background: COVID-19 and the policies to contain it have been a social problem and public health emer-gency for people in Italy in 2020. The aim of the study is assessing the prevalence of depression symptoms among nursing students from the University of Palermo during the COVID-19 pandemic. Materials and methods: The study employed a cross-sectional study design. On April 2020, a survey was performed including all the nursing students of the University of Palermo. The survey was structured into two parts. The first part consisted in the collection of socio-demographic information, the second in the administration of the QIDS-SR16 questionnaire. A multivariable logistic regression model was used to elaborate the results and adjusted Odds Ratios are presented. Results: The sample consisted of 525 students (70.3% female). The probability to have a moderate/severe/very severe depressive symptomatology is significantly associated with the following variables: "Female gender" (aOR 1.96), "Low perceived economic status" (aOR 2.32), "Low perceived health status" (aOR 2.30) and "To be a smoker" (aOR 2.24). Conclusions: The global pandemic and the efforts to contain it represent a unique event and offer the oppor-tunity to advance our understanding of how to provide mental health care focused on online psychoeducation and psychotherapy programs for young students.

Le nuove centralità sono le grandi aree funzio- nali individuate dallo schema di massima del Piano Regolatore Generale di Palermo per il 2025, opzionate in base al Piano strategico del- la città che le individua come punti di forza del sistema urbano rispetto al contesto regionale. Individuano le aree nelle quali sono localizzati i servizi di rango elevato che fanno della città un polo gravitazionale rispetto al suo ambito metropolitano. La loro funzione si dispiega anche a livello urbano, potenziando, rifunzio- nalizzando, o rilocalizzando, attività di servizio a scala urbana e sovralocale.

La città di Palermo ha una vocazione multiculturale ed è luogo dell’integrazione e dell’accoglienza. Questa sua caratteristica è confermata dalla partecipazione attiva e propositiva alla redazione della “Carta di Palermo” del 2015 sui temi della mobilità umana internazionale da parte di numerose organizzazioni non governative e realtà associative, accanto alle istituzioni pubbliche. Palermo, come modello positivo di contaminazione culturale e di città collaborativa, lancia la proposta di andare oltre il permesso di soggiorno per approdare al concetto di “cittadinanza di residenza”, riconoscendo il diritto alla mobilità come diritto della persona umana. La migrazione non deve essere considerata un problema ma una risorsa: dalla valorizzazione delle differenze culturali emerge l’uomo-cittadino, un soggetto attivo in grado di dare valore alla comunità e al luogo in cui risiede. La conoscenza reciproca, la parità di trattamento, la partecipazione democratica, la governance condivisa sono i principi base della città collaborativa, una città capace di offrire a tutti i cittadini spazi e servizi necessari a coltivare relazioni sociali, ad alimentare il senso di appartenenza ad una comunità, ad accrescere l’identità singola e collettiva, a prendersi cura dei cosiddetti beni comuni, ovvero i beni pubblici con valore sociale.

Purpose Depression is a common and serious medical illness, considered as a public health issue because it interferes with the interpersonal, social and professional functioning of the individual, and its frequency is constantly increasing. According to a recent review, approximately 34 per cent of nursing students had experienced depression worldwide. The university period may represent a moment in which the mental well-being of students is subjected to stress with a relative predisposition to the development of diseases related to mood disorders. The purpose of this study is to estimate the prevalence and examine the socio-demographic correlates of depressive symptomatology. Design/methodology/approach In April 2019, a questionnaire was administered to all the nursing students of University of Palermo of the three years of course, accompanied by informed consent. Multivariable logistic regression was performed. The statistical significance level chosen for all analyses was 0.05. The results were analyzed using the STATA statistical software version 14. Results are expressed as adjusted odds ratio (aOR) with 95 per cent confidence intervals. Findings The sample consists of 493 students who completed the questionnaire, and the average age of the sample participants is 21.88 years. The multivariable logistic regression model shows that the risk to have depressive symptomatology is significantly associated with the following independent variables: female gender (aOR 1.91), being single (aOR 1.87), second year of study (aOR 1.94), third year of study (aOR 1.92), not performing regular physical activity (aOR 1.78) and perceived low health status (aOR 3.08). Originality/value This study shows that belonging to the female gender, being further along in the years of study, having a chronic illness and perceiving a low state of health are all factors that can increase the risk of developing the symptoms of depression; rather, regular physical activity, friendship and romantic relationships can be considered factors protecting them from the risk of falling into depression that can undermine both the study and work performance. Certainly, it is important to analyze all the involved variables to improve the global health not only of the nursing students but of all the students.

Objective A cross-sectional study on knowledge, perceptions, and adherence to cervical cancer screening was conducted using telephone interviews of Sicilian women that were performed in 2016. This study aimed to identify areas that need to be addressed to improve the validity of data collection and to minimize possible biases. Methods We performed a qualitative study through SWOT analysis, which is a multidimensional method based on evaluation of Strengths (S), Weaknesses (W), Opportunities (O), and Threats (T) of the research project. The contents of the SWOT forms underwent categorical, inductive, and deductive data analysis using the long table analysis method. Results The full availability of an updated address and phone number list was the main organizational aspect to be addressed. Socio-cultural context played a major role for understanding the questions and for acceptability of the topics. In some cases, a family member was a facilitating element, while in others, the family member hindered the interviews. Active involvement of general practitioners was considered essential for success of the interviews. Conclusions When performing a cross-sectional survey, organizational aspects and active involvement of general practitioners are crucial in the enrolment phase, regardless of the socio-cultural context.

BACKGROUND: The aim of this study was to evaluate the knowledge and attitude of Health Sciences students towards vaccinations, investigating the differences that may exist in different Italian Universities. METHODS: It was a multicenter cross-sectional survey, using a validated on-line questionnaire. Amultivariate logistic regression analysis was performed in order to evaluate the association between geographical distribution and vaccination behavior. RESULTS: Acollection of 3131 questionnaires was made in order to show that students from the seven northernmost Italian Universities tended to be more satisfied with their knowledge on vaccinations (aOR 0.82), but also that they were less likely to recommended it to patients, family members, general population (aOR 0.69) or to other healthcare workers (aOR 0.72). Nevertheless, the study showed that they were more likely to be in favor of the possible introduction of mandatory vaccinations for healthcare workers (aOR 3.73), compared to students from the seven southernmost Italian Universities. CONCLUSIONS: This study highlighted the importance of education and the differences that existed on this issue among Italian students, and the need to establish a core curriculum of Public Health that is common to all Italian Universities.

Vaccine hesitancy (VH) is a complex and country-specific issue, responsible for the decreasing vaccination rate and subsequent spread of vaccine-preventable diseases. In literature, several questionnaires were developed to assess VH. The aim of this systematic review was to evaluate the published questionnaires assessing parental VH. The search was conducted in PubMed/Medline, Web of Science and The Cochrane Library, in December 2017, following the PRISMA guidelines. The search strategy included 4 types of keywords: parents, vaccine hesitancy/acceptance, immunization and survey. Only English and Italian original papers were included. 17 reviewers independently screened titles and abstracts. Only the included articles were downloaded in full and, after a second screening, data were extracted and recorded in an ad hoc spreadsheet. A total of 5,139 articles were retrieved, after duplicates elimination 3,508 papers were screened. After a screening selection, 334 studies were included in the analysis. Most studies were cross-sectional (92.8%), followed by case-control (4.8%) and cohort studies (2.4%). The population interviewed was mainly parents, without any further details (73.1%); mothers were the only parent surveyed in approximately 20% of the studies, while only 1 study involved selectively the fathers. The sample size ranged from 7 to 59,897. Only 38% of the included studies reported both the number and type of items used. Regarding the type, more than half consisted of closed questions, followed by Likert scales, while open-ended questions were used in 14.8% of the surveys. Frequently, the survey was conducted using a self-reported questionnaire or interview. The questionnaires were mostly administered on paper, while online forms were used in 20.1% of the cases. However, 80.2% of the questionnaires were not attached to the paper. HPV vaccine was the most frequently investigated (39.2%), followed by influenza (13.5%) and measles (10.8%). While 22.4% of the articles referred to paediatrics vaccinations in general. Data about the immunization behaviours were reported in 294 studies: the subjects involved showed a behaviour defined as “acceptance” in 129 studies (38.6%), as “hesitancy/scepticism/doubt” in 145 studies (43.1%) and as “refusal” in 22 studies (6.6%). This information was not reported in 12% of the studies. VH is still a public health challenge, as confirmed by the high number of studies and questionnaires retrieved. This study offers a deeper perspec- tive on the available questionnaires, helping to identify the best one in terms of aim and study setting., Journal of Preventive Medicine and Hygiene, Vol. 61 No. 3 (2020): 2020613

Introduction: Sexually transmitted diseases are an emerging problem especially among young people, increasing the burden of disease in this population. The aim of the study was to evaluate sexual habits, sexual relations and knowledge of STIs among the students in the nursing science course of the University of Palermo. Materials and Methods: In April 2019, a survey was provided to students that investigate on: personal information and habits, knowledge of sexually transmitted diseases, anti-HPV vaccination. Multivariable logistic regression was performed, considering it as a dependent variable “Have you occasionally had unprotected sex (without a condom)? Yes”, in order to evaluate the role of the variables of the questionnaire. Results are expressed as adjusted Odds Ratio (aOR). Results: 405 students completed the questionnaire. The mean age of the sample is 21.65 years, 69.63% of the interviewees are women. The multivariable logistic regression shows that the risk of having occasional unprotected sex (without condom) is significantly associated with “Do you permanently have unprotected sex (without a condom)? Yes” (aOR 4.46); “Have you ever received information on sex education and/or sexually transmitted diseases? No” (aOR 6.02); “Age Class

Higher risk of death from COVID-19 among patients with cancer was correlated with male sex, greater age, presence of multiple comorbidities, advanced-stage disease, and active disease; there was no association between risk and anticancer treatment., The SARS-CoV-2 pandemic significantly affected oncology practice across the globe. There is uncertainty as to the contribution of patients' demographics and oncologic features to severity and mortality from COVID-19 and little guidance as to the role of anticancer and anti–COVID-19 therapy in this population. In a multicenter study of 890 patients with cancer with confirmed COVID-19, we demonstrated a worsening gradient of mortality from breast cancer to hematologic malignancies and showed that male gender, older age, and number of comorbidities identify a subset of patients with significantly worse mortality rates from COVID-19. Provision of chemotherapy, targeted therapy, or immunotherapy did not worsen mortality. Exposure to antimalarials was associated with improved mortality rates independent of baseline prognostic factors. This study highlights the clinical utility of demographic factors for individualized risk stratification of patients and supports further research into emerging anti–COVID-19 therapeutics in SARS-CoV-2–infected patients with cancer. Significance: In this observational study of 890 patients with cancer diagnosed with SARS-CoV-2, mortality was 33.6% and predicted by male gender, age ≥65, and comorbidity burden. Delivery of cancer therapy was not detrimental to severity or mortality from COVID-19. These patients should be the focus of shielding efforts during the SARS-CoV-2 pandemic. This article is highlighted in the In This Issue feature, p. 1426

In questo contributo viene evidenziato il programma della ricerca-azione sul tema generale della rigenerazione urbana presentata nel volume che in parte raccoglie la selezione degli interventi svolti ad una conferenza del 16 dicembre 2016 nella sede del Rettorato, Palazzo Chiaramonte Steri. Alla selezione dei contributi della conferenza sono stati integrati altri contributi scientifici e progettuali che attestano le dinamiche di trasformazione del litorale costiero di levante a Palermo anche pper dimostrare con evidenza empiricha che anche in contesti local i particolarmente complessi è possibile svolgere una corretta animazione territoriale ben se ben organizzata e focalizzata per il raggiungimento di obiettivi precisi e raggiungibili almeno in parte. La realizzazione del porto di S. Erasmo è la concretizzazione di un processo di ricerca-azione maturato a partire dalla conferenza del 2016, e costituisce un avvio di un processso di completamento più lungo che coinvolgerà gradualmente l'intera costa. Il recupero della costa di Palermo viene inteso come caso di studio da interpretare come occasione per riflettere sui modi di intervento nelle fasce costiere di grandi città del Mediterraneo nel quadro del dibattito più ampio del valore del paesaggio in Italia ed in Europa. This contribution highlights the research-action program on the general theme of urban regeneration presented in the volume which in part collects the selection of the interventions carried out at a conference on December 16, 2016, in the Rectorate, Palazzo Chiaramonte Steri. Other scientific and design contributions were integrated into the selection of the conference contributions, attesting to the dynamics of transformation of the eastern coastal coast in Palermo also to demonstrate empirically that even in particularly complex local contexts it is possible to carry out a correct territorial animation well if well organized and focused on achieving precise and at least partially achievable objectives. The construction of the port of S. Erasmo is the concretization of a research-action process matured since the 2016 conference and constitutes the start of a longer completion process that will gradually involve the entire coast. The recovery of the coast of Palermo is intended as a case study to be interpreted as an opportunity to reflect on the methods of intervention in the coastal strips of large Mediterranean cities within the framework of the broader debate on the value of the landscape in Italy and in Europe.

[Introduction] Desmoid tumour (DT) is a locally aggressive fibroblastic proliferative disease representing the most common extraintestinal manifestation of familial adenomatosis polyposis (FAP). As data on the activity of chemotherapy in these patients are limited, we examined the outcomes of patients treated with low-dose methotrexate (MTX)+vinca alkaloids (vinorelbine or vinblastine)., [Patients and methods] We retrospectively reviewed clinical and outcome data from all patients with confirmed FAP-associated DTs treated with weekly MTX+vinca alkaloids in seven European sarcoma reference centres between January 2000 and December 2018. Radiological responses were assessed using RECIST V.1.0 and V.1.1. The Kaplan-Meier method associated to the log-rank test was used to estimate and compare survival curves., [Results] We identified 37 patients (median age 29 years, range 7–44). According to RECIST, 20/37 (54.1%) patients achieved partial response (PR), 15/37 (40.5%) patients had stable disease and 2/37 (5.4%) had progressive disease as best response. Overall, the median progression-free survival (PFS) was 6.5 years (range, 0.3–12.1 years). In the subset of patients achieving PR as best response, the median PFS was not reached. In a subset of 11 patients with progressive disease offered MTX+vinca alkaloids rechallenge (after chemotherapy withdrawal following prolonged disease control), the disease control rate was 100%, resulting in a median PFS after rechallenge of 5.8 years., [Conclusions] This is the largest series on the activity of low-dose chemotherapy in patients with FAP-related DT. In this population, MTX+vinca alkaloids is an active combination, as already reported in patients with sporadic DT.

Background:Despite the free-of-charge offer of influenza vaccines to at-risk subgroups, vaccine coverage remains low and far from the target, probably due to the false myths and misperceptions. We aimed to explore the healthcare students’ vaccination behavior and beliefs to find any association between vaccination uptake during the last 5 years and future vaccination acceptance.Study design:A multicentre cross-sectional study.Methods:From Oct 2017 to Nov 2018, the Italian healthcare students from 14 different universities in 2017/2018 were enrolled, through an online and anonymous questionnaire previously validated. Absolute and relative frequencies were calculated and Pearson's Chi-square test was used. A multinomial logistic regression model was performed. Results are expressed as relative Risk Ratio (RR) with 95% Confidence Intervals (95% CI). The level of significance chosen was P-value Results:A total of 3137 students were enrolled and 3131 questionnaires were analysed. 82.7% of the sample declared they had not received any flu vaccination during the last 5 years. Students who received flu vaccination 4 times or more during the last 5 years were more likely to do it again next year as well (95.1% vs 4.9%). The regression model showed that having received flu vaccination over the last 5 years was statistically associated with the intention of getting vaccinated during next season.Conclusions:Frequency of flu vaccination is predictive for future acceptance among healthcare students. This association could have both implications for the organization of vaccination campaigns and improve educational strategies for this category of students.

Mai come adesso le grandi città italiane sembrano affette dalla mancanza ‘e/o dalla ricerca della loro bellezza. Città come Milano o Napoli alimentano, soprattutto in alcune loro parti, la diffusione di immagini del cambiamento culturale in corso. Roma, sia pur afflitta dalle criticità severe in materia di rifiuti e di manutenzione del bene pubblico, rimane ‘la città eterna’ che sa offrire la sua immensa dotazione di beni culturali anche senza alcuna organizzazione gestionale. Palermo (2016-2018) si trova nella condizione ottimale di capitale nazionale della cultura e di ospitare la Biennale nomade ‘Manifesta’ giunta alla dodicesima edizione. Il contributo cerca di mettere in evidenza le condizioni di base delle risorse culturali ed ambientali di quello che l’Amministrazione intende offrire come bene primario: la costa e i contesti culturali ed ambientali direttamente ed indirettamente correlati sia in senso fisico-spaziale che in senso simbolico e narrativo. La vista del mare davanti la città di Palermo non è un dato banale: è la conquista di un diritto di cittadinanza a lungo negato e non ancora pienamente utilizzato. Nei paragrafi sono illustrati: alcuni aspetti notevoli della strumentazione per il governo del territorio costiero, considerazioni sugli effetti in termini culturali del mancato o insufficiente governo della costa. Nelle conclusioni il contributo indica la necessità di una piena condivisione delle ipotesi di generazione e rigenerazione urbana nella considerazione dell’alto livello di complessità sia delle strumentazioni e degli approcci disciplinari da considerare che delle attese spesso conflittuali degli attori coinvolti nel processo di innovazione sociale in atto. Never before have the great Italian cities seem affected by the lack and / or the search for their beauty. Cities like Milan or Naples feed, especially in some of their parts, the diffusion of images of the cultural change underway. Rome, albeit afflicted by severe problems regarding waste and maintenance of the public good, remains the 'Eternal City' that can offer its immense endowment of cultural heritage even without any management organization. Palermo (2016-2018) is in the optimal condition of national capital of culture and of hosting the 'Manifesta' nomadic Biennale, now in its twelfth edition. The contribution seeks to highlight the basic conditions of the cultural and environmental resources of what the Administration intends to offer as a primary asset: the coast and the cultural and environmental contexts directly and indirectly correlated both in a physical-spatial sense and in a symbolic and narrative. The view of the sea in front of the city of Palermo is not a trivial fact: it is the conquest of a right of citizenship that has long been denied and not yet fully used. In the paragraphs are illustrated: some notable aspects of the instrumentation for the governance of the coastal territory, considerations on the effects in cultural terms of the lack of or insufficient government of the coast. In the conclusions, the contribution indicates the need for full sharing of the hypotheses of urban generation and regeneration in consideration of the high level of complexity both of the instrumentation and disciplinary approaches to be considered and of the often conflicting expectations of the actors involved in the ongoing social innovation process .

BacKGrOUnD: the aim of the study was to estimate the prevalence of gambling, internet addiction disease and the risk of alcohol consumption among workers of the “Paolo Giaccone” University hospital in Palermo. MethODs: the study employed a cross-sectional study design. an anonymous online survey was provided accompanied by informed consent. The questionnaire was structured into four parts. The first section investigates on socio-demographic information. in the other sections of the questionnaires were administered: internet addiction test, alcohol Use Disorders Identification Test-Consumption and Canadian Problem Gambling Index. A multivariable logistic regression model was used and adjusted odds ratios (aOr) are presented. RESULTS: The final sample size consists of 1482 subjects (response rate 79.42%). The 2.29% of the employees are at risk of pathological alcohol consumption, 0.47% has several problems due to the internet, and 2.77% are considered problematic gambling players. The several problems due to the internet is significantly associated with the following independent variables: age at increasing unit (aOr 0.71), at risk for consumption of alcohol (aOr 92.37), at risk for gambling (aOr 53.67). CONCLUSIONS: Along with the growing availability of information technology, individuals may experience adverse outcomes when internet usage is combined with alcohol risky consumption and gambling. since the increased access to addictive substances/behaviors leads to higher rates of addiction, future prospective studies and preventive measures should be implemented to reduce internet use, alcohol assumption and gambling in this population.

BACKGROUND: abuse of alcohol among students is a problem that has not to be undervalued because it can damage mental and global health and, as a consequence, it can negatively influence the academic and training performance roping at the end on patients’ health. Our study focused particularly on nursing students of the University of Palermo of the three years of course with the aim to estimate the prevalence of risky alcohol consumption and to analyze the associated factors. MethODs: in april 2019 a questionnaire was administered to all the nursing students of University of Palermo of the three years of course, accompanied by informed consent. Multivariable logistic regression was performed. the statistical significance level chosen for all analyzes was 0.05. The results were analyzed using the STATA statistical software version 14. Results are expressed as adjusted Odds Ratio (aOR) with 95% Confidence Intervals (95% CI). resULts: the sample consists of 493 (67.55% female) students that completed the questionnaire. the multivariable logistic regression model shows that the risk to have risky consumption of alcohol is significantly associated with the following independent variables: female gender (aOr 1.91); age class

The burden of pancreatic cancer varies greatly across countries, with the number of deaths, incident cases, and disability-adjusted life years more than doubling in recent years, and with high-income countries having the highest incidence and mortality rates. We conducted this systematic review with meta-analysis with the goal of summarizing the current evidence on dietary fiber intake and its role in reducing the risk of pancreatic cancer, given the importance of identifying risk factors. This systematic review followed the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The structured literature search was conducted on PubMed/Medline and Scopus, combining free text words and medical subject headings. Our review contained 18 records at the end of the process. Our results show that dietary fiber intake reduces the risk of pancreatic cancer. When the analysis was differentiated according to the type of fiber considered, sub-grouped by gender (reduction of around 60% among women), and when case-control studies were conducted, the strength of the association increased. Clinicians and policymakers should improve interventions to raise the population’s awareness regarding the consumption of high-fiber diets, both in practice and in terms of public health policy.

he number of people travelling internationally increases year after year, mainly due to the more and more affordable cost of travelling and to the evergreater ease of transportation. Nowadays, any destination can be reached within 24 hours by plane, and the improvement of economic conditions facilitates both business and leisure travelling, as a matter of fact, according to data from the World Tourism Organization, the number of international trips is expected to increase by 3% to 4% per year.1 However, international travelling poses various health risks depending on travelers’ health conditions and the type of trip undertaken. Indeed, travelers may experience sudden changes in altitude, humidity, and temperature that can cause illness. Furthermore, serious health risks can result from poorquality housing, poor sanitary conditions, inadequate medical services, and the unavailability of drinking water. Potential risks strictly depend on the destination and the characteristics of the travel, and for this reason, anybody planning a trip should seek advice on the potential risks related to their destination and understand the protective measures needed to minimize the risk of contracting a disease. The risk of infection is linked to the epidemiology of the single country and to the different climatic conditions, which could expose travelers to etiological agents and vectors which are different from those which can be found in their countries of origin, but also to lower sanitary levels. Although doctors and tour operators can provide great help and good advice, it is crucial that travelers seek further information, understand the risks associated with travelling, and take the necessary precautions during their journey in order to travel safely. New technologies and application for smartphone (also known as app) might help more and more in promoting healthy behaviors.2 The greatest strength of health-related apps is that information is provided through channels already used by the citizen and perceived as “friendly.” Moreover, apps are a great way to communicate in “one-to-many” mode, in contrast to the standard “one-to-one” healthcare approach; this exponentially increases the quantity of educational content sent. Furthermore, by using the app, users produce new electronic data and make it available to researchers and policy makers, thus creating a new field of big-data-based research.3, 4 The aim of this study was to develop an applications for smartphones (“iViaggio: the travel app, traveling in safety”) (Figure 1), designed to provide information about the main risks associated with travelling, also taking into consideration the kind of trip (health risks related to environment, accidents, traumas, and violence, potential risks of infectious diseases).

Background: Pictorial warnings may contribute to lower attractiveness of smoking, particularly among adolescents. The present study compared the impact of two different label styles of tobacco product warnings (textual and pictorial) among adolescents in a new standardized way, using the Adolescent Label Impact Index (ALII). Methods: A school-based cross-sectional study was conducted. Adolescent aged 10–20 years completed an online questionnaire. The ALII score was used to assess the impact of only-textual (ALII-T) and pictorial advertisements (ALII-P). Results: A total of 1,759 students (68.4% response-rate) declared that graphic warnings have a significant impact than textual ones (p < 0.05). The younger group, which has never smoked or just tried and believed in the harmful effects of tobacco, is associated with both scales of ALII scales (T and P) (p < 0.01). The socioeconomic status was associated with ALII-T (p < 0.01), but not ALII-P; female gender, smoker-peers, perception of the body weight are related to the ALII-P (p < 0.05) but not ALII-T. Conclusions: The pictorial labels represent a policy of tobacco use control that has potential effects, in particular in reducing communication inequalities between socio-economic categories, reinforcing the knowledge about the damage of smoking, discouraging adolescents, especially the younger ones who do not have never smoked or have just tried to become smokers.Collaborative Group Siriana Campioni, Department of Public Health and Infectious Disease, “Sapienza” University of Rome Gabriele Castorina, Armando Platania, Specialization School of Hygiene and Preventive Medicine, Department “GF Ingrassia” Hygiene and Public Health, University of Catania, Italy; Ilenia Bellini, School of Specialization in Hygiene and Preventive Medicine, University of Florence Omar Enzo Santangelo, Specialization School of Hygiene and Preventive Medicine, Department of Sciences for Health Promotion and Mother and Child Care “Giuseppe D’Alessandro,” University of Palermo Clara Ferrara, Department of Gynecology and Obstetrics Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli) Palermo, Italy.

BACKGROUND: Problematic internet use is a growing problem in modern societies. Internet addiction (IA ) can be defined as a behavioral addiction between human and information technology-machine. Our aim was to identify IA among Palermo University nursing students by means of the Internet Addiction Test. METHODS: The study employed a cross-sectional study design. In April 2019 a survey was provided to students who attend daily lessons. The questionnaire was structured into two parts. The first section investigates on socio-demographic information, year of study, the perception of the economic and health status. In the second section of the questionnaire IAT was administered. A multivariable logistic regression model was used and adjusted Odds Ratios (aOR) are presented. RESULTS: The sample size consists of 413 students. Risk to have several problems due to the internet is significantly associated with the following independent variables: male gender (aOR 1.77, 95% CI : 0.89-3.52,); being single (aOR 3.14, 95% CI : 1.31-7.55); third year of study (aOR 2.99, 95% CI : 1.27-7.05,); to be student off-site (aOR 2.80, 95% CI : 1.07-7.36); low perceived health status (aOR 3.19, 95% CI : 1.52-6.67). CONCLUSIONS : Even though generally lower prevalence has resulted from our study in comparison with different geographical areas, IA is confirmed as an emerging problem among the young population of our Region, potentially threatening the health among university students.

It is estimated that about the 12% of world’s couples are infertile, and half of these infertility cases are due to male factors. The main conditions that can affect male fertility are asthenozoospermia and oligozoospermia. For the first time, we analysed semen headspace in order to characterize the pattern of Volatile Organic Compounds (VOCs) in human seminal fluid and to identify specific metabolites that may be potential biomarkers of pathological conditions. By headspace solid-phase microextrac- tion-gas chromatography-mass spectrometry (HS-SPME-GC-MS) method, we detected both endogenous and exogenous compounds that form a complex mix of metabolites with a high inter- individual biological variability. Nevertheless, it was possible to point out the interconnection between some VOCs and asthenozoospermia and/or oligozoospermia. Furthermore, this work emphasizes the importance of semen as matrix for metabolomic studies that usually focus on other biological fluids.

Introduction. We aimed at carrying out a quantitative and qualitative analysis of claims for adverse events addressed to Palermo University Hospital Policlinico “Paolo Giaccone” in order to promote evidence-based interventions and increase patient safety. Methods. A retrospective study of 296 claims collected between 1st of January, 2014 and 31st of December, 2017 by Quality and Clinical Risk Management staff unit was performed along with descriptive analysis of any associated determinant factors. Results. The most frequent causes of claims consisted of wrong surgical procedures (33.8%), mistaken diagnoses (18.6%), falls (17.6%), infections (6.4%), postoperative complications (5.4%) and wrong therapies (3.1%). At the end of the survey, the judicial process was not concluded in the majority of cases (82.8%). Claims were closed by receipt payment in 12.2% of cases, without any payment in 5.1%. Conclusions. Clinical risk management plays a pivotal role in providing information and tools to prevent medical adverse events, avoid claims addressed to hospitals and improve the quality of health care. Evoluzione della gestione dei rischio clinico nel siste-ma sanitario: indagine sugli eventi avversi verificatasi nell'Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo.

BACKGROUND: One of the often-underestimated aspects of obesity is the psychological one. In particular, there is a growing attention to the correlation between obesity and depression among students from all over the world. And also towards the correlation between alcohol abuse and mood disorders. The objective of the study was to examine if the depressive symptomatology, risk of consumption of alcohol and anxiety symptomatology are correlated with obesity/ overweight in a sample of students of the University of Palermo, Italy. METHODS: The study was a cross-sectional study. A questionnaire is structured in four sections. An anonymous online survey was sent to a random students sample enrolled in the mailing list of the Regional Authority for the Right to University Study (ERSU) of the University of Palermo, who signed an informed consent. Results are expressed as adjusted Odds Ratio (aOR) with 95% Confidence Intervals (95% CI). P value

BACKGROUND: The university student is vulnerable to the adverse effects of many stress factors that can lead to an increase in the burden of illness in young people. The objective of the study was to estimate the prevalence of anxious symptoms in the student population of the degree course in nursing at the University of Palermo. METHODS: The study design is observational. In the month of April 2019, a survey was provided to all nursing students of University of Palermo of the three years of course, accompanied by informed consent. The statistical significance level chosen for all analyzes was 0.05. The results were analyzed using the STATA statistical software version 14.XX Results are expressed as adjusted Odds Ratio (aOR) with 95% Confidence Intervals (95% CI). This study was approved by the ethical committee of the University Hospital "P. Giaccone" of Palermo, Minutes No. 02/2019 (15. Studio A.D.A.3) of February 18, 2019. RESULTS : The sample size consists of 493 students that agreed to the informed consent and completed the questionnaire. The average age of the sample is 21.88 years (standard deviation±3.38), 67.55% of the interviewees are women. Regarding bivariate analysis, statistically significant differences were found for the following variables: "gender," "year of study," "do you perform regular physical activity," "perceived health status." The analysis shows that the risk to have anxious symptomatology moderate-severe is significantly associated with the following independent variables: female gender (aOR 2.83, 95% CI : 1.26-6.38, P=0.012); age class

The aim of the study was to evaluate depressive symptomatology within the student population of the University of Palermo (Italy). An anonymous online questionnaire was provided to the students of the University of Palermo. The first section investigated demographic and social data, while in the second section the QIDSSR16 (Quick Inventory of Depressive Symptomatology Self-Report) test was administered. 539 students (68.3% female) gave informed consent and completed the questionnaire. Considering as a dependent variable: Depressive symptomatology moderate-severe-very severe, the statistically significant independent variables associated are I don't live with my family (aOR 1.63, 95% CI 1.01-2.63, P=0.043), I currently smoke (aOR 1.55, 95% CI 1.01-2.39, P=0.048) and Low perceived health status (aOR 4.14, 95% CI 2.73-6.28, P

Introduction. The internationally adopted child is a fragile subject who often shows an incomplete health documentation, which hinders the complete assessment of health status. Materials and Methods. Between January 2010 and June 2016, at the University Hospital "AOUP P. Giaccone" of Palermo, we reviewed the health documentations of 111 children recently arrived in Italy following the conclusion of the international adoption procedure. 62.2% of the children were male, of various nationalities and with an average age of 7 years (± 3.4). This study aims to detect, in the observed sample, the reliability of the vaccinal documentation and the real acquired immunization. We intend to estimate the presence of IgG against Measles, Mumps, Rubella and Hepatitis B viruses. Results. Percentages of subjects with a complete correspondence between documentation attesting the successful vaccination and the effective immunization were: 78% for measles, 66% for mumps, 84% for rubella, 71% for hepatitis B. Percentages of subjects without vaccinal documentation but with positive evidence of IgG were: 50% for measles, 38% for mumps, 71% for rubella, 50% for hepatitis B. Conclusion. The partial correspondence found between vaccinations performed and real immune status can be attributed to several reasons: poor reliability of the received health documentation, the complex economic situation of the health services in the countries of origin, the incorrect vaccines storage or the administration beyond the expiration date, the poor immunological response due to concomitant diseases or severe malnutrition, the probable non-administration of the expected booster dose. Particular attention needs to be paid to this population, which may represent a risk group susceptible to vaccine-preventable diseases.

Background: Adenosine triphosphate bioluminescence produced by the firefly luciferase has been successfullyintroduced to verify cleaning procedures in the food industry according to the Hazard Analysis Critical Control Pointprogram.Our aim was to evaluate the reliability of bioluminescence as a tool to monitor the effectiveness of sanitation in healthcaresettings, in comparison with the microbiological gold standard.Methods: 614 surfaces of various material were randomly sampled in Policlinico University Hospital units in Palermo,Italy, to detect adenosine triphosphate bioluminescence and aerobic colony count. Linear regression model andPearson correlation coefficient were used to estimate the relationship between the two variables of the study.Results: Aerobic colony count median was 1.71 colony forming units/cm2 (interquartile range = 3.8), whereasadenosine triphosphate median was 59.9 relative light units/cm2 (interquartile range = 128.3). Pearson coefficientR2 was 0.09. Sensitivity and specificity of bioluminescence test with respect to microbiology were 46% and 71%,whereas positive predictive value and negative predictive value were 53% and 65%, respectively.Conclusion: According to our results, there seemed to be no linear correlation between aerobic colony countand adenosine triphosphate values, suggesting that current bioluminescence technology has not any proportionalrelationships with culturable microbes contaminating environmental surfaces in health-care settings.

During the university period, student wellbeing is exposed to the negative effects of many stressful factors, including the use and abuse of alcoholic beverages. The aim of this study is to estimate the risky alcohol consumption within the student population of the University of Palermo.An anonymous online questionnaire was provided to students enrolled in the mailing list of the Regional Agency for the Right to University Study (ERSU) of the University of Palermo. the first section investigated demographic and social data, while in the second section the A.U.D.I.T. C (Alcohol Use Disorders Identification Test-Consumption) test was administered.539 subjects agreed to the informed consent and completed the questionnaire. The average age of the sample is 22.65 years (SD ± 2.95). Considering as dependent variable "students with risky consumption of alcohol", the statistically significant independent variables associated were: "age class ≤22 years old" (aOR 2.02, 95% CI 1.18-3.44, p=0.019), "don't live with own family" (aOR 3.21, 95% CI 1.81-5.69, p0.001) and "I currently smoke" (aOR 6.44, 95% CI 3.85-10.79, p0.001).The results of the study show that about 19% of students experience risky alcohol consumption. This percentage seems not to be gender related. Information and training campaigns focused on alcoholism and related risks are of great importance in order to educate students on the socio-economic costs of alcohol related diseases to public health; parents can play a crucial role in minimising the use of alcohol in their sons/children through dialogue if properly trained to address these issues. In fact, our study seems to show that those who no longer live in the household have a higher risk of alcohol consumption.

In Sicilia, a fronte di un incremento dell’estensione dello screening organizzato del cervicocarcinoma, non corrisponde un aumento dell’adesione. Nei mesi di gennaio-giugno 2016 è stata condotta un’indagine trasversale somministrando un questionario standardizzato a un campione di 365 donne, per descrivere le ragioni del fenomeno e promuovere interventi mirati. Per le variabili di atteggiamento e conoscenza è stato utilizzato l’Health Belief Model, che ha esplorato la percezione della donna della suscettibilità (rischio di sviluppare il cancro), della gravità della patologia e dei benefici derivanti dal pap-test. Dai risultati emerge che il 66,6% delle intervistate ha effettuato un pap- test nell’ultimo triennio (valore nazionale 79,2%); il consiglio da parte di un operatore sanitario e la suscettibilità percepita sono associati a una maggiore adesione allo screening. Il potenziamento dei programmi organizzati di screening e l’intervento attivo del medico di medicina generale rappresentano strategie efficaci di promozione dello screening.

To correlate the level of oxidative stress in serum and seminal fluid and the level of sperm deoxyribonucleic acid (DNA) fragmentation with sperm mitochondrial respiratory efficiency.Sperm mitochondrial respiratory activity was evaluated with a polarographic assay of oxygen consumption carried out in hypotonically treated sperm cells. A possible relationship between sperm mitochondrial respiratory efficiency, the level of oxidative stress, and the level of sperm DNA fragmentation was investigated.Sperm motility was positively correlated with mitochondrial respiration but negatively correlated with oxidative stress and DNA fragmentation. Interestingly, sperm mitochondrial respiratory activity was negatively affected by oxidative stress and DNA fragmentation.Our data indicate that sperm mitochondrial respiration is decreased in patients with high levels of reactive oxygen species by an uncoupling between electron transport and adenosine triphosphate synthesis. This reduction in mitochondrial functionality might be 1 of the reasons responsible for the decrease in spermatozoa motility.

Introduzione: Abitudini alimentari poco sane hanno ricadute negative sulla salute pubblica. Il servizio di ristorazione universitario è diventato protagonista della salute e del benessere collettivo di studenti e lavoratori. In conseguenza a ciò nasce la necessità di acquisire informazioni sulla popolazione che usufruisce delle mense al fine di costruirne il profilo di salute e cercare di migliorarlo. Metodi: È stata condotta una survey su un campione di utenti delle mense dell’ERSU di Palermo, tramite somministrazione di un questionario con lo scopo di valutare il consumo alimentare secondo il modello della dieta mediterranea (DM). È stato ideato uno score di aderenza (SA) alla piramide della DM moderna. Risultati: Il campione è composto da 494 utenti dei quali 271 donne (54,8%), 488 (98,8%) studenti, con un’età mediana di 21 (IQR 3). Di questi, 150 (32,0%) risultano avere una medio-buona aderenza alla DM secondo l’SA dei quali 40 (26,7%) sono studenti fuori sede, 37 (24,7%) sono pendolari, 38 (25,3%) sono in sede e 35 (23,3%) sono ospiti di Residenze universitarie. Inoltre 51 dichiarano di mangiare formaggio 2-4 v/week (34,2%), 75 non hanno mai fumato (50,7%) e poco meno della metà di essi svolge regolare attività fisica (46,9%). Dall’analisi multivariata le variabili che risultano essere direttamente associate con una maggiore aderenza allo score sono: studente pendolare (OR 2.2, p=0.013), consumare formaggio 2-4 v/week (OR 2.1, p=0.001). Conclusioni: La survey ha evidenziato una scarsa aderenza degli studenti universitari al modello alimentare della DM. Le mense universitarie rappresentano un settore della ristorazione collettiva in cui si concentrano peculiari valenze di tipo preventivo, educativo e nutrizionale; per tali motivi rappresenta un’occasione privilegiata in cui possono svilupparsi e diffondersi strategie educative che si propongono di instaurare e potenziare un approccio corretto nei riguardi delle abitudini alimentari. Dichiarazione conflitto di interesse: nessuno.

Introduzione: la presenza di superfi ci contaminate in ambito sanitario è correlata all’aumentato rischio di infezioni associate all’assistenza (healthcare associated infections, HAIs), in quanto costituiscono serbatoio ambientale per gli agenti patogeni. Il monitoraggio dell’effi cacia dei processi di sanifi cazione risulta pertanto cruciale allo scopo di ridurre tale rischio, e la ricerca di un metodo affi dabile, economico e rapido è tutt’ora in fase di studio. Obiettivi: lo scopo di tale studio è stato quello di valutare l’affi dabilità di un metodo bioluminometrico basato sulla rilevazione dell’adenosina trifosfato (ATP), come alternativa rapida ed economica alla conta microbiologica delle colonie di batteri aerobi (Aerobic Colony Count, ACC), considerato attualmente il gold standard nella rilevazione della contaminazione delle superfi ci. Materiali e Metodi: 614 superfi ci sono state campionate in modo random in tutte le unità operative dell’ospedale Policlinico Paolo Giaccone dell’Università degli Studi di Palermo, tramite prelievo di un tampone specifi co per entrambe le metodiche. Le misurazioni sono state successivamente analizzate tramite il modello di regressione lineare ed il calcolo del coeffi ciente di correlazione di Pearson. Risultati: il valore mediano dell’ACC di tutte le superfi ci campionate è risultato pari a 1.71 Unità Fomanti Colonie (Colony Forming Units, CFU)/cm2 (range interquartile IQR = 3.8), mentre il corrispettivo valore mediano bioluminometrico ammonta a 59.9 Relative Light Units /cm2 (RLU/cm2; IQR = 128.3). Il coeffi - ciente di Pearson R2 è pari a 0.09. Conclusioni: in base ai risultati di tale studio, non sembra esistere una correlazione lineare suffi cientemente forte e signifi cativa tra la conta ACC ed i valori bioluminometrici di ATP; pertanto l’impiego della bioluminescenza come fattore predittivo del rischio infettivo non è suffi cientemente affi dabile. Nonostante le tecniche microbiologiche siano più dispendiose sia in termini di tempo sia di costi economici, esse costituiscono ancora il gold standard per tale genere di valutazione, poiché il rischio di HAIs è maggiormente correlato alla contaminazione delle superfi ci da parte di agenti patogeni specifi ci piuttosto che di generico materiale organico rilevato dal bioluminometro.

Introduzione: Il programma di ricerca è finalizzato allo studio del grado di sviluppo organizzativo dei “modelli sistemici” per la qualità dell’assistenza nelle strutture sanitarie pubbliche e private siciliane, prendendo spunto dalla rilevazione condotta dalla Direzione Generale della Programmazione sanitaria, dei livelli di assistenza e dei principi etici di sistema del Ministero della Salute nel 2007 a livello nazionale. Materiali e Metodi: Il questionario è stato progettato per la compilazione on line, prevedendo domande miranti a rilevare il livello di diffusione degli strumenti e dei metodi per il miglioramento della qualità dell’assistenza, in riferimento all’anno 2013, ed è stato inoltrato tramite e-mail ai Direttori sanitari delle Aziende Sanitarie pubbliche e delle Case di Cura private, nel mese di marzo 2014. Per l’analisi statistica dei dati è stato utilizzato il software R versione 3.0.2. Risultati: Hanno risposto il 64,21% delle strutture sanitarie siciliane. Oltre all’accreditamento istituzionale o a quello previsto dal progetto “Patient Safety” di Joint Commission International (JCI), l’86% del campione afferma di aver adottato uno o più sistemi di gestione per la qualità/ modelli di accreditamento volontario/di eccellenza: tra questi il sistema ISO:9000 è quello più diffuso, confermando i risultati della Rilevazione ministeriale del 2007, seguito dal modello di accreditamento della JCI. La quasi totalità del campione inoltre dichiara di organizzare riunioni e/o corsi di formazione rivolti al personale aziendale per favorire le conoscenze sull’accreditamento istituzionale e/o sui sistemi di gestione per la qualità/modelli di accreditamento volontario/di eccellenza, e la totalità delle strutture partecipanti dichiara di effettuare degli audit interni coinvolgendo diverse figure professionali. Tutte le Aziende sanitarie e Case di cura partecipanti allo studio ritengono inoltre di aver conseguito uno o più obiettivi, tra riduzione di inefficienze e relativi costi, miglioramento del rapporto con l’utenza, riduzione del numero di reclami, riduzione delle non conformità, miglioramento della motivazione personale e del clima interno: anche in questo caso i risultati risultano in linea con quelli della Rilevazione ministeriale, e testimoniano come l’adozione dei sistemi di gestione per la qualità/modelli di accreditamento volontario/ di eccellenza, ed in generale di tutte le iniziative volte al miglioramento della qualità aziendale si traducano nel raggiungimento di obiettivi importanti, sia in termini di assistenza sanitaria che di modus operandi all’interno della realtà aziendale. Uno dei limiti del presente studio è rappresentato dall’uso di un unico questionario per poter paragonare strutture sanitarie molto disomogenee tra di loro sia in termini strutturali che organizzativi. I dati riportati dalla maggior parte delle aziende che hanno preso parte allo studio, testimoniano la sensibilità degli operatori e delle istituzioni verso la tematica del miglioramento della qualità, tuttavia, vi è ancora una limitata attenzione al processo di comunicazione come strumento di progressiva trasparenza verso tutti gli interlocutori del sistema. Proprio perché il governo clinico ha come obiettivo il miglioramento della qualità dell’assistenza, non può non avere una spiccata attenzione all’uso delle informazioni scientifiche ed alla gestione della conoscenza come riferimento per le decisioni cliniche, al fine di orientarle verso una maggiore efficacia ed appropriatezza clinica.

Background. The migration of people has always accompanied the history of man and produced a gradual but constant reorganization of the coordinates of the ethnic and cultural world. Today, all of this continues to undergo a profound acceleration, taking aback often unprepared governments and the same population and generating fears, mostly unfounded concerns and prejudices that make complex a peaceful and necessary integration. The purpose of this study is understand the actual perception of immigrants from a sample of students who live in Western Sicily. Methods. A cross-sectional survey was carried out, throughout an anonymous questionnaire, to all students attending a high school in Castellammare del Golfo, in Sicily close to an Acceptance Centers for Asylum Seekers (CARA). This questionnaire contains a series of questions that take into account different aspects of Immigration (socio-demographic and health aspects). Results. The sample consists of 253 students attending a high school in Sicily, of which 176 (69.6%) are females. 187 of these (73.9%) think that there are too much immigrants in Italy. The reasons that push migrants to come to Italy, for their opinion, are considered the economic ones (204, 80.6%) and logistic ones (ease of entry) (71, 28.1%). Half of this sample (136, 53.8%) knows the CARA in their town. 106 (41.9%) of respondents tend to be agree on the possibility that immigration promotes the spread of terrorism and crime. Considering health aspects, 61 (24.1%) of the students believe that the most frequent pathology into a CARA is tuberculosis (tb), instead 66 (26.1%) think about respiratory illness. 106 (41.9%) of respondents believe that immigrants can transmit specific diseases, such as tb (36, 33.9%) and all the pathologies examined (gastroenteritis, tuberculosis, respiratory illness with fever, meningitis) (34, 32.1%). Furthermore it was performed a multivariate logistic analysis between the variable of who think that immigrants can transmit infectious diseases and the other ones. The results show that this variable is directly associated with the idea that the main cause of hospitalization among male immigrants is the same infectious diseases (OR= 3.15 p=0.007). On the other side this variable is inversely associated with being little (OR=0.04 p=0.009) and not at all (OR=0.27 p=0.02) agree with the idea that immigrants can promote the spread of terrorism. Conclusion. These data suggest that the knowledge about migrants is not still sufficient, and that the perception of the foreign is still marked by prejudices. The research aimed to investigate the perception of these adolescents compared to immigrants, an indispensable prerequisite to give tools able to inform people properly on immigration with particular reference to health topics and to fight prejudices and stereotypes in healthcare.